DEBATE DEBATE

When I received this article by Naomar de Almeida Filho for comment, I recalled his paper entitled Current Problems and Perspectives in Epidemiological Research in Social Medicine, which provided the basis for the book Epidemiologia sem Números (Epidemiology Without Numbers). Written in the 1980s, the book was a major stimulus for reflection on epidemiological knowledge. I now perceive the same daring and generous characteristic of open-mindedness, debating even with himself, instigating, full of questions that incite us to think.

The article's goal is to conduct a preliminary evaluation of conditions allowing for a General Theory of Health, seeking to achieve the scientific construction of the object "health" through models of health and disease. The authors asks: Is a General Theory of Health feasible? Can health be treated as a scientific object? Does this undertaking involve an underlying philosophical problem or some essential epistemological obstacle? Is health a problem for science or a question that relates to life?

Such queries are now emerging acutely in the field of Collective Health, insofar as the notion of health promotion is increasingly identified as a perspective for intervention. Traditional Public Health models are based on a negative object, namely disease. How does one attain the inverse of this object? How does one construct positive models for knowledge and intervention in health without a specific theoretical construct defining health?

No scientific definition of health has been found to date. Understood as positivity, health has a meaning as broad as the very notion of life itself. When we refer to terms such as well-being and quality of life, linked to the idea of promoting health, we are in fact dealing with ontological questions like pleasure, virtue, and happiness. No matter how concise and transdisciplinary the attempt may be, there is no way of translating such life experiences into a scientific concept. From this existential perspective, health can only be defined as enunciated by Canguilhem (1990): "a commonplace concept or a philosophical question".

However, it is certain that the possibility of a philosophical health does not prevent one from taking health as a scientific object. Once again Canguilhem states (1990:35): "The recognition of health as the truth of bodies in the ontological sense not only can but should admit the presence - as a margin and barrier, properly speaking - of truth in its logical sense, that is, science. The living body is certainly not an object, but for man, to live is also to know".

The health field has structured itself historically as linked to medicine, but from the point of view of Collective Health, the construction of truth in the logical sense is not limited to medicine. Collective Health is a prime space for opening to, and interface with, other areas that legitimately produce knowledge on health. However, no matter how integrated and broad this knowledge is, it does not fail to be a construction of truth in the logical sense, presenting itself "as a margin and a barrier" vis-à-vis the purpose of promoting the health of populations. What are the possibilities and limits of a field of knowledge and practices in dealing with an "object" that has an ontological meaning?

The complexity of the relationship between knowledge and existence is at the root of the difficulty in elaborating a positive concept of health. There is no theory capable of resolving the tension between life defined as subjective experience and that which is the object of sciences. Life Science defines health by its inverse, but without the inexorability of pain and suffering would a field of health make sense? Is the problem the fact that we do not work with positive concepts of health, or is it the implication of constituting a concept of disease in modernity, or even the form in which this concept is organized in practices that either favor or jeopardize life?

In this sense, the issue is not to solve the incompleteness of such knowledge but precisely to know how to accept it. I do not mean to disqualify such knowledge, but to qualify it in the sense of reinforcing the need to reflect on how to link health knowledge to the perspective of being truly useful for health promotion, that is, promotion of life. This involves affirming a complementary approach in action between mutually different languages, restating the importance of the role of philosophy, art, and politics.

In the solving concrete problems, knowing how to relativize the importance of knowledge without overlooking it is not a simple issue and is not a task for a specific field. Recognition of this limit implies a world view transformation which would certainly be translated specifically into profound changes in the logic of training human resources and formulating and operationalizing health practices.

The effort to construct scientific knowledge on health from a synthetic perspective is highly pertinent, seeking to integrate the multiple and complex dimensions of this object. But this transdisciplinary stance, as the author states, is organized around problems and not disciplines, demanding alternative and plural modes of understanding. From this broad view, would it not be contradictory to conceive a General Theory of Health? This, because it would not be one theory, but as many theories as there were alternative and plural modes of approaching this object.

CANGUILHEM, G., 1990. La Santé: Concept Vulgaire e Question Philosophique. Paris: Sables.